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Screening und Monitoring der fetalen Versorgung in der Schwangerschaft

Screening and monitoring of fetal supply in pregnancy

  • Leitthema
  • Published:
Der Gynäkologe Aims and scope

Zusammenfassung

Hintergrund

Die Überwachung der fetalen Versorgung provoziert unter Experten für fetale Medizin immer noch Diskussionen. Es gibt zahlreiche Verfahren, die zurzeit in der Schwangerschaft Anwendung finden.

Fragestellung

Dieser Artikel soll einen Überblick geben über die wichtigsten Diagnostikmöglichkeiten, die Aufschluss über die fetale Versorgung geben.

Ergebnisse

Auf folgende Diagnoseverfahren und die Evidenz zum Einsatz wird im Detail eingegangen: Erfassung von Wachstum, Dopplersonographie, Kardiotokogramm (CTG) sowie Beurteilung von fetalen Bewegungen und des biophysikalischen Profils.

Diskussion

Als wichtigstes Beispiel für die eingeschränkte fetale Versorgung wird die aktuelle Datenlage zur Wachstumsrestriktion dargestellt.

Abstract

Background

Surveillance of fetal supply still provokes discussions among experts in fetal medicine. There are many different tools that can be currently applied during pregnancy.

Objective

This article provides information about the most frequently used monitoring tools which provide information about the fetal supply.

Results

The following diagnostic procedures and the evidence for their use will be discussed in detail: assessment of fetal growth, fetal movements, and measurement of biophysical profile score, Doppler ultrasonography and cardiotocography (CTG).

Discussion

Fetal growth restriction, which is the most prominent example for restricted fetal supply, is discussed in the following article based on current data.

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Literatur

  1. Alfirevic Z, Stampalija T, Medley N (2015) Fetal and umbilical Doppler ultrasound in normal pregnancy. Cochrane Database Syst Rev CD001450:

    Google Scholar 

  2. Alfirevic Z, Stampalija T, Gyte GM (2013) Fetal and umbilical Doppler ultrasound in high-risk pregnancies. Cochrane Database Syst Rev CD007529:

    Google Scholar 

  3. Barker DJ, Winter PD, Osmond C et al (1989) Weight in infancy and death from ischaemic heart disease. Lancet 334:577–580

    Article  Google Scholar 

  4. Bricker L, Neilson JP, Dowswell T (2008) Routine ultrasound in late pregnancy (after 24 weeks’ gestation. Cochrane Database Syst Rev CD001451:

    Google Scholar 

  5. Burkhardt T, Schäffer L, Zimmermann R, Kurmanavicius J (2008) Newborn weight charts underestimate the incidence of low birthweight in preterm infants. Am J Obstet Gynecol 199(139):1–6

    Google Scholar 

  6. Chauhan SP, Cole J, Sanderson M et al (2006) Suspicion of intrauterine growth restriction: use of abdominal circumference alone or estimated fetal weight below. J Matern Fetal Neonatal Med 10(19):557–562

    Article  Google Scholar 

  7. Crispi F, Bijnens B, Figueras F et al (2010) Fetal growth restriction results in remodeled and less efficient hearts in children. Circulation 121:2427–2436

    Article  PubMed  Google Scholar 

  8. Cruz-Martínez R, Figueras F, Hernandez-Andrade E et al (2011) Fetal brain doppler to predict cesarean delivery for nonreassuring fetal status in term small-for-gestational-age fetuses. Obstet Gynecol 117:618–626

    Article  PubMed  Google Scholar 

  9. Eixarch E, Meler E, Iraola A et al (2008) Neurodevelopmental outcome in 2-year-old infants who were small-for-gestational age term fetuses with cerebral blood flow redistribution. Ultrasound Obstet Gynecol 32:894–899

    Article  CAS  PubMed  Google Scholar 

  10. Figueras F, Gratacós E (2014) Update on the diagnosis and classification of fetal growth restriction and proposal of a stage-based management protocol. Fetal Diagn Ther 36:86–98

    Article  PubMed  Google Scholar 

  11. Figueras F, Oros D, Cruz-Martinez R et al (2009) Neurobehaviour in term, small-for-gestational age infants with normal placental function. Pediatrics 124:e934–e941

    Article  PubMed  Google Scholar 

  12. Figueras F, Figueras J, Meler E et al (2007) Customised birthweight standards accurately predict perinatal morbidity. Arch Dis Child Fetal Neonatal Ed 92:F277–F280

    Article  PubMed Central  PubMed  Google Scholar 

  13. Flenady V, Koopmans L, Middleton P et al (2011) Major risk factors for stillbirth in high-income countries: a systematic review and meta-analysis. Lancet 377:1331–1340

    Article  PubMed  Google Scholar 

  14. Frøen JF, Gardosi JO, Thurmann A et al (2004) Restricted fetal growth in sudden intrauterine unexplained death. Acta Obstet Gynecol Scand 83:801–807

    Article  PubMed  Google Scholar 

  15. Gardosi J, Chang A, Kalyan B et al (1992) Customised antenatal growth charts. Lancet 339:283–287

    Article  CAS  PubMed  Google Scholar 

  16. Gnirs J, Schelling M, Kolben M, Schneider KTM (1998) Referenzkurven für das fetale Bewegungsprofil. Geburtsh Frauenheilkd 58:355–362

    Article  Google Scholar 

  17. Grivell RM, Alfirevic Z, Gyte GM, Devane D (2012) Antenatal cardiotocography for fetal assessment. Cochrane Database Syst Rev CD007863:

    Google Scholar 

  18. Hadlock FP, Harrist RB, Sharman RS et al (1985) Estimation of fetal weight with the use of head, body, and femur measurements – a prospective study. Am J Obstet Gynecol 151:333–337

    Article  CAS  PubMed  Google Scholar 

  19. Lalor JG, Fawole B, Alfirevic Z, Devane D (2008) Biophysical profile for fetal assessment in high risk pregnancies. Cochrane Database Syst Rev CD000038. doi: 10.1002/14651858

  20. Lees CC, Marlow N (2015) 2 year neurodevelopmental and intermediate perinatal outcomes in infants with very preterm fetal growth restriction (TRUFFLE): a randomised trial. Lancet 385:2162–2172

    Article  PubMed  Google Scholar 

  21. Leitlinien Doppler: http://www.awmf.org/uploads/tx_szleitlinien/015-019l_S1_Doppplersonographie_in_der_Schwangerschaft_2013-03.pdf

  22. Leitlinie CTG in Schwangerschaft: http://www.awmf.org/uploads/tx_szleitlinien/015-036l_S1_CTG_Schwangerschaft_Geburt_2014-06.pdf

  23. Mongelli M, Chew S, Yuxin NG, Biswas A (2005) Third-trimester ultrasound dating algorithms derived from pregnancies conceived with artificial reproductive techniques. Ultrasound Obstet Gynecol 26:129–131

    Article  CAS  PubMed  Google Scholar 

  24. Morse K, Williams A, Gardosi J (2009) Fetal growth screening by fundal height measurement. Best Pract Res Clin Obstet Gynaecol 23:809–818

    Article  PubMed  Google Scholar 

  25. Mul T, Mongelli M, Gardosi J (1996) A comparative analysis of second-trimester ultrasound dating formulae in pregnancies conceived with artificial reproductive techniques. Ultrasound Obstet Gynecol 8:397–402

    Article  CAS  PubMed  Google Scholar 

  26. Mutterschaftsrichtlinien (2015) https://www.g-ba.de/downloads/62-492-1007/RL_Mutter-2015-02-19_2015-05-05.pdf

  27. Neilson JP (2010) Ultrasound for fetal assessment in early pregnancy. Cochrane Database Syst Re CD000182

  28. Nicholson JM, Kellar LC, Henning GF et al (2015) The association between the regular use of preventive labour induction and improved term birth outcomes: findings of a systematic review and meta-analysis. BJOG 122:773–784

    Article  CAS  PubMed  Google Scholar 

  29. Odibo AO, Francis A, Cahill AG et al (2011) Association between pregnancy complications and small-for-gestational-age birth weight defined by customized fetal growth standard versus a population-based standard. J Matern Fetal Neonatal Med 24:411–417

    Article  PubMed  Google Scholar 

  30. Oros D, Figueras F, Cruz-Martinez R et al (2011) Longitudinal changes in uterine, umbilical and fetal cerebral Doppler indices in late-onset small-for-gestational age fetuses. Ultrasound Obstet Gynecol 37:191–195

    Article  CAS  PubMed  Google Scholar 

  31. Owen P, Donnet ML, Ogston SA et al (1996) Standards for ultrasound fetal growth velocity. BJOG 103:60–69

    Article  CAS  Google Scholar 

  32. Pattison N, McCowan L (2010) Cardiotocography for antepartum fetal assessment. Cochrane Database Syst Rev CD001068

  33. Romo A, Carceller R, Tobajas J (2009) Intrauterine growth retardation (IUGR): epidemiology and etiology. Pediatr Endocrinol Rev 3(6 Suppl):332–336

    Google Scholar 

  34. Scioscia M, Vimercati A, Ceci O et al (2008) Estimation of birth weight by two-dimensional ultrasonography: a critical appraisal of its accuracy. Obstet Gynecol 111:57–65

    Article  PubMed  Google Scholar 

  35. Souka AP, Papastefanou I, Pilalis A et al (2012) Performance of third-trimester ultrasound for prediction of small-for-gestational-age neonates and evaluation of contingency screening policies. Ultrasound Obstet Gynecol 39:535–542

    Article  CAS  PubMed  Google Scholar 

  36. Souka AP, Papastefanou I, Pilalis A et al (2013) Performance of the ultrasound examination in the early and late third trimester for the prediction of birth weight deviations. Prenat Diagn 22:1–6

    Article  Google Scholar 

  37. Staisch KJ, Westlake JR, Bashore RA (2008) Blind oxytocin challenge test and perinatal outcome. Am J Obstet Gynecol 138:399–403

    Article  Google Scholar 

  38. Trudell AS, Cahill AG, Tuuli MG et al (2013) Risk of stillbirth after 37 weeks in pregnancies complicated by small-for-gestational-age fetuses. Am J Obstet Gynecol 208(5):376.e1–376.e7

    Article  Google Scholar 

  39. Voigt M, Fusch C, Olbertz D et al (2006) Analyse des Neugeborenenkollektivs der Bundesrepunlik Deutschland. 12. Mitteilung: Vorstellung engmaschiger Perzentilwerte (Kurven) für die Körpermaße Neugeborener. Geburtshilfe Frauenheilkd 06:956–970

    Article  Google Scholar 

  40. Wood S, Cooper S, Ross S (2014) Does induction of labour increase the risk of caesarean section? A systematic review and meta-analysis of trials in women with intact membranes. BJOG 121:674–685

    Article  CAS  PubMed  Google Scholar 

  41. Schneider H, (Hrsg.) et al (2015) Die Geburtshilfe. Springer Verlag, Berlin Heidelberg

    Book  Google Scholar 

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Authors and Affiliations

  1. Frauenklinik und Poliklinik, Klinikum rechts der Isar der Technischen Universität München, Ismaninger Str. 22, 81675, München, Deutschland

    S. M. Lobmaier & K. T. M. Schneider

Authors
  1. S. M. Lobmaier
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  2. K. T. M. Schneider
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Correspondence to S. M. Lobmaier.

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Interessenkonflikt

S.M. Lobmaier und K.T.M. Schneider geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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R. Zimmermann, Zürich

U. Gembruch, Bonn

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Lobmaier, S.M., Schneider, K.T.M. Screening und Monitoring der fetalen Versorgung in der Schwangerschaft. Gynäkologe 48, 725–731 (2015). https://doi.org/10.1007/s00129-015-3789-6

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  • DOI: https://doi.org/10.1007/s00129-015-3789-6

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